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COX <br /> �� � N� ep <br /> a X/fi nk R <br /> APP d St rage rSPect/on 6j1o1' <br /> �n a//n oy> <br /> operator✓isv to 3 <br /> ogj, <br /> Se o� � <br /> Designated US rnsvB� <br /> /NFO I-10N v, 1PuanGe j5go <br /> es <br /> f, fAC/L/TY „ _ <br /> Gill�Siv � , <br /> GEKSID <br /> fig <br /> fBfl4> <br /> na <br /> Snett <br /> Facility Name rives ` <br /> i <br /> FacilityAddtess RrNFOt�" <br /> Is"? .Hamme uSTOPE�rO <br /> p SrOPg� i <br /> 1. DES/GNATE � <br /> esignated U � - <br /> Name ofDt� <br /> Fernando <br /> Cetti�calia� <br /> Fom q <br /> /Ccf, roved,OMB N.$05000; <br /> 10191916-- s, I <br /> �� et)U9�96qiC FLE <br /> 09 Q 1 9 3 9 1.3 <br /> NYmeur <br />� v `� m33001r1DDD <br /> Quant w1 N,,. w.m ceas <br /> WNER/OPERATOR ACKNOWLEDGEMENT OF INSPECTION RESULTS top p <br /> I have reviewed the results of the designated UST operator inspection report and provided a _ <br /> description of the action(s)taken or to be taken to correct any compliance issues discovered. <br /> Name of UST Owner/Operator(print) <br /> i UST Owner/Operator Signature <br />� Date Signed <br /> :28130 <br /> 7. INSPECTION HISTORY <br /> Has each follow-up action of Section 3 from the previous Designated UST Yes No NA 1 x 5 5 <br />/ ,J ry proper stopping name,and a <br /> Operator Inspection Report been corn feted a 7 9wations.IF export shipment and I am th, <br />/ (Attach documentation verif in a p appropriately? awe <br /> y g ppropriate service to this report.) ❑ [( ❑ <br /> S. RELEASE DETECTION ALARM HISTORY an <br /> Attach a copy of the alarm history report/jog to this report. <br /> Is the monitoring system powered on and in proper operating mode? Yes No NA <br /> B ❑ N9onlh <br /> Has each alarm since the previous inspection been responded to appropriately? �,onth <br /> (Attach documentation verifying appropriate service to this report.) ❑ ❑ �( <br /> Have all containment sumps, that have had an alarm since the previous tial Rejection <br /> C <br /> designated UST operator inspection report, been responded to by a qualified <br /> service technician? ❑ ❑ <br /> 1 <br /> A//answers marked `No"must be described by the designated UST operator in Section 3. <br /> Page 2 of 4 <br /> MISC-1612WHAM-0511612023 <br /> 1 <br />